Project Inclusion: Service Gaps and Barriers

Between March and October 2017, Pivot travelled to ten communities across the province to interview people impacted by the intersection of BC’s housing and drug policy crises. Participants’ stories brought the human toll of these crises to light and helped us better understand where our laws, policies, and collective belief systems are failing us. They also provided critical insight into how we might begin to chart a path for building healthy and inclusive communities throughout BC.

Project Inclusion participants identified specific service providers as critical sources of safety, support, and community. We know that we could not have undertaken this project without the openness and dedication of overtaxed frontline service providers.

Despite the many highly skilled service providers working tirelessly to support people in their communities, participants in every region identified ways in which health and social services fail to meet the needs of people experiencing homelessness and people who are criminalized as a result of substance use.

Decades of defunding and resulting privatization of services for people who live in deep poverty has created a patchwork system of service delivery, where the number and types of services available, rules for clients, and oversight standards vary arbitrarily from municipality to municipality. There are very real and direct health, safety, and human rights implications that arise where services are not available or accessible to marginalized people.

We identified three major areas where gaps and barriers are substantially undermining health and safety:

provincial income support programs;

shelters; and

hospitals.

In one town we visited, we connected with a soft-spoken woman we met at an emergency shelter where she was staying. She was doing her best to make herself comfortable near the shelter’s front door, despite the fact that she was in extreme physical pain. We later learned that she was also living with advanced cancer.

After the death of a parent, she was alone for the first time and living on basic income assistance. Unable to find housing, she was now homeless in the same community she had lived in all her life. We could not help but ask: how, in contemporary British Columbia, could this situation even happen?

Some of the answer lies in the need for more low-income housing options and increases to income assistance rates. Across BC, there are also too few safe drop-in services, shelter spaces, harm reduction services, treatment beds, and advocacy services to meet the most basic needs of people living in poverty. However, we also need to dig deeper and critically examine the ideologies and beliefs that underlie the development and delivery of many essential services.

Income Assistance

The provincial government has described income assistance, known colloquially as welfare, as a “program of last resort”. Even if we accept that dissuading people from accessing income assistance is a legitimate policy goal, which we dispute, it is clear that the notion that welfare is and should be a last resort for people has been taken to such an extreme that it is causing objective harm to people in need, the communities in which they live, and society as a whole.

Someone is like, 'Get a fucking job.' Well, if that person… doesn’t have an alarm clock, doesn’t have food, doesn’t have something nice to wear, they are not going to get a job and then they are not going to be able to go to work. You need somewhere, somebody, to help you somewhere along the line. –373*

Once this cycle of poverty begins, a person may become entrenched in homelessness. The cycle makes it increasingly difficult to re-enter the labour or housing market.

Shelters

Shelters are not an answer to BC’s housing crisis; however, as long as homelessness remains a reality in this province, it is critical that everyone in need has access to safe shelter that meets their needs on a more than overnight basis. Even where shelter beds are available on an overnight basis, they often do not address people’s need to have somewhere to spend time and attend to basic needs during the day.

We stayed [in the shelter] during the night, [they] kicked us out early in the morning, then we have to find shelter for the day… We are not allowed to put up a tent or little tarp over us. –13*

Not only are there limits on the hours shelters are open each day, some shelters also have restrictions on how many nights in a row people can stay or how many nights they can stay in a given month despite the lack of any affordable housing options for shelter residents.

Hospitals

Across the province, Project Inclusion participants felt that their local hospitals discriminated against people who use substances.

If they know that you’ve used or whatever, they red flag you. So, it pops up on the computer that you’re a drug addict or that you have addiction issues. So, basically… they’re done with you then. –181*

Project Inclusion participants made it clear that BC hospitals are poorly equipped to deal with the reality that people who use substances also have legitimate health and pain issues. Hospitals are also failing to accommodate patients experiencing withdrawal symptoms while receiving care. There is strong evidence that experiences of stigma and discrimination when accessing health care are compounded for Indigenous Project Inclusion participants.

The Path Forward

People who took part in this study had a lot of positive things to say about some of the service providers who make real differences in their lives and in their communities. However, stigma is embedded in the fabric of health and social services in a way that is undermining public health, perpetuating criminalization, and, in some cases, leading to violations of human rights. For many participants, government, and non-profit services feel like unsafe, inaccessible institutions.

Government offices are horrible, like I actually trip over my tongue, I can’t talk in them. –416*

As we spoke to people around the province, three simple themes emerged that should guide service design and delivery around the province: the need to work with people who use substances and people experiencing homelessness to ensure that services and systems are accessible and navigable for those who need them most; increased support for peer-driven and peer-delivered services; and ensuring that everyone who accesses any service is treated with respect. That may require more financial resources, but it will definitely require undoing the underlying stigma that informs everything from punitive income assistance policies to the negative experiences people have with service providers during a health crisis.

*Note: numbers indicate Project Inclusion participants and were used to protect their identity.

Core toProject Inclusion are our recommendations to provincial and federal politicians and law makers. Pivot is committed to fighting for these recommendations to become enshrined in law, but we need your help to carry out this work. Bymaking a gift to Pivot Legal Society today, you’ll help ensure that our advocacy can continue and that we can hold lawmakers accountable for their actions and policies.

We invite you to join us in recognizing that we are on stolen lands of the Musqueam, Squamish, and Tsleil-Waututh peoples. We are grateful to Indigenous Peoples for their continuous relationship with their lands and are committed to learning to work in solidarity as accomplices in shifting the colonial default.